Provider Demographics
NPI:1407862287
Name:PHARMACY CARE PA
Entity Type:Organization
Organization Name:PHARMACY CARE PA
Other - Org Name:MAIN STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:620-582-2134
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:113 E. MAIN
Mailing Address - City:COLDWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67029-0236
Mailing Address - Country:US
Mailing Address - Phone:620-582-2134
Mailing Address - Fax:620-582-2920
Practice Address - Street 1:113 E. MAIN
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:KS
Practice Address - Zip Code:67029-0236
Practice Address - Country:US
Practice Address - Phone:620-582-2134
Practice Address - Fax:620-582-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-096473336C0003X, 3336C0004X, 3336H0001X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100445020AMedicaid
KS1701920OtherNABP
KS2-09647OtherPHARMACY LICENSE
KS4241310001Medicare PIN